北京市三级甲等医院青年医护人员职业倦怠现状及其影响因素分析

Job Burnout and Associated Factors among Young Health Care Providers in Tertiary Grade A Hospitals in Beijing

背景当前,我国医护人员普遍存在职业倦怠现象,尤其是北京市三级甲等医院,因吸引了全国各地的重症患者前来就诊,使得相关医护人员、特别是青年医护人员的工作负荷和工作压力过大,职业倦怠现象更加严重。目的分析北京市三级甲等医院青年医护人员职业倦怠现状及其主要影响因素,为医院管理者对青年医护人员职业倦怠进行有效预防和干预提供依据。方法 2016年8—10月采用多阶段分层抽样方法,随机抽取北京市5家三级甲等医院(首都医科大学附属北京安贞医院、首都医科大学附属北京友谊医院、北京积水潭医院、北京中医医院、北京回龙观医院)年龄<35岁的674名在职青年医护人员作为调查对象。共发放问卷674份,收回有效问卷663份,有效回收率为98.4%。调查问卷由一般信息调查表和职业倦怠量表组成。在职青年医护人员职业倦怠影响因素分析采用多因素Logistic回归分析。结果 663名在职青年医护人员情感衰竭维度得分22(0,54)分,去人性化维度得分6(0,29)分,个人成就感维度得分31(0,48)分。根据M氏常模与杭州地区护士常模对在职青年医护人员职业倦怠情况进行评价,去人性化、个人成就感分布比较,差异均有统计学意义(P<0.05)。663名在职青年医护人员职业倦怠检出率为65.0%(431/663),其中轻度倦怠、中度倦怠、重度倦怠分别有224名(33.8%)、129名(19.5%)、78名(11.8%)。多因素Logistic回归分析结果显示,性别、生活压力、科室、月收入、职业喜爱程度、伴随疾病数量是重度情感衰竭的影响因素;心理减压培训、职业喜爱程度、伴随疾病数量是重度去人性化的影响因素;心理减压培训、科室、工作要求、职业喜爱程度是重度个人成就感低的影响因素;心理减压培训、职业喜爱程度、伴随疾病数量是重度职业倦怠的影响因素(P<0.05)。结论北京市在职青年医护人员职业倦怠呈现较高水平,建议医院管理部门对青年医护人员开展系统的职业认同和专业自我概念等职业价值观教育,定期组织心理减压培训和文体锻炼活动,缓解职业倦怠。

Background Nowadays,job burnout is widespread in health care providers in China.For those who work at tertiary grade A hospitals in Beijing,especially the young,they suffer more due to excessive work load and pressure caused by a great number of visits from all over the country.Objective To investigate and analyze the job burnout and main associated factors among young health care providers in tertiary grade A hospitals in Beijing,so as to provide a basis for hospital managers to enact and formulate targeted effective prevention and intervention measures.Methods We conducted this cross-sectional study from August to October 2016.We enrolled 674 in-service health care providers aged less than 35 years from 5 tertiary grade A hospitals in Beijing（Beijing Anzhen Hospital,Capital Medical University;Beijing Friendship Hospital,Capital Medical University;Beijing Jishuitan Hospital;Beijing Hospital of Traditional Chinese Medicine;Beijing Huilongguan Hospital） by multistage and stratified random sampling and surveyed them by a questionnaire composing of a demographic data scale and the Chinese version of Maslach Burnout Inventory-Human Services Survey（MBI-HSS）.The survey achieved a response rate of 98.4%（663/674）.Multivariate Logistic regression analysis was performed to investigate the associated factors for the job burnout in in-service young health care providers.Results The average scores of the 663 final participants for the 3 dimensions,emotional exhaustion,depersonalization and reduced personal accomplishment,were 22（0,54）,6（0,29）and 31（0,48） respectively.The average scores of depersonalization and reduced personal accomplishment were significantly differenced between the M norm and Hangzhou norm of nurses（P〈0.05）.The overall prevalence,prevalence of mild,moderate and severe level of job burnout was 65.0%（431/663）,33.8%（224/663）,19.5%（129/663）,11.8%（78/663）,respectively.Multivariate Logistic regression analysis found that,severe level of emotional exhaustion significantly varied by sex,pressures of life,department,monthly income,degree of cherishing the job position,number of concomitant diseases（P〈0.05）;severe level of depersonalization notably associated with the psychological decompression training,degree of cherishing the job position and number of concomitant diseases（P〈0.05）;psychological decompression training,department,job requirements and degree of cherishing the job position were associated factors for severe level of reduced personal accomplishment（P〈0.05）;psychological decompression training,degree of cherishing the job position and number of concomitant diseases were the factors substantially associated with severe level of job burnout（P〈0.05）.Conclusion The young health care providers in Beijing are under a high risk of job burnout.In view of this,it is recommended that the hospital management departments should carry out professional identity,professional self-concept and other professional values education,and regular psychological decompression training as well as recreational and sports activities to alleviate job burnout.